ATS
HOME HELP FEEDBACK SUBSCRIPTIONS ARCHIVE SEARCH TABLE OF CONTENTS
QUICK SEARCH:   [advanced]


     

This Article
Right arrow Full Text
Right arrow Full Text (PDF)
Right arrow Alert me when this article is cited
Right arrow Alert me if a correction is posted
Right arrow Citation Map
Services
Right arrow Email this article to a friend
Right arrow Similar articles in this journal
Right arrow Similar articles in PubMed
Right arrow Alert me to new issues of the journal
Right arrow Add to Personal Folders
Right arrow Download to citation manager
Right arrow Permission Requests
Citing Articles
Right arrow Citing Articles via HighWire
Right arrow Citing Articles via Google Scholar
Google Scholar
Right arrow Articles by Agarwal, R.
Right arrow Articles by Cherian, K. M.
Right arrow Search for Related Content
PubMed
Right arrow PubMed Citation
Right arrow Articles by Agarwal, R.
Right arrow Articles by Cherian, K. M.
Related Collections
Right arrowRelated Article

Ann Thorac Surg 1999;67:432-436
© 1999 The Society of Thoracic Surgeons

Original Articles

Transmyocardial laser revascularization: early results and 1-year follow-up

Ravi Agarwal, MCha, Mullasari Ajit, DMa, Valikapathalil M. Kurian, MCha, Sethuratnam Rajan, MCha, Sarasa B. Arumugam, MDa, Kottoorathu M. Cherian, FRACSa

a Institute of Cardiovascular Diseases, Madras, India

Accepted for publication July 14, 1998.

Address reprint requests to Dr Cherian, Institute of Cardiovascular Diseases, 4-A, Dr. Jayalalitha Nagar, Mogappair, Madras-600 050, India
e-mail: mmmbits{at}giasmd01.vsnl.net.in

Background. Transmyocardial revascularization using a high-energy CO2 laser has emerged as a new therapeutic option for patients with severe diffuse coronary artery disease refractory to conventional modes of therapy.

Methods. From December 1994 to September 1997, 102 patients underwent isolated transmyocardial revascularization. The mean age was 56.7 ± 9.2 years and 92.15% were men. Mean preoperative angina class and ejection fraction were 2.6 ± 0.7 and 44.7% ± 10.5%, respectively. Diabetes was present in 49.01% of patients, 32.3% had history of previous myocardial infarction, and 12.7% had undergone a previous coronary artery bypass graft procedure. An average number of 23 ± 8 channels were created in each patient using an 800-W CO2 laser.

Results. The early mortality was 14.7% and univariate predictors of mortality were age more than 55 years, female sex, creatine kinase more than 1,600 IU, absence of intercoronary collaterals, and mean pulmonary artery pressure greater than 21 mm Hg. At 1-year follow-up there was significant improvement in angina class and effort tolerance but no significant change in left ventricular ejection fraction.

Conclusions. We conclude that transmyocardial revascularization provides symptomatic benefit and improves exercise tolerance in a group of patients suffering from disabling angina not amenable to other modes of treatment. The high early mortality can be brought down with strict patient selection criteria. The mechanism of beneficial effects is uncertain and patency of laser channels is controversial, but laser-induced neoangiogenesis is being looked on as a possible explanation.


Related Article

Robert J. March
Ann. Thorac. Surg. 1999 67: 436. [Extract] [Full Text] [PDF]



This article has been cited by other articles:


Home page
 J Am Coll CardiolHome page
M. B. Leon, R. Kornowski, W. E. Downey, G. Weisz, D. S. Baim, R. O. Bonow, R. C. Hendel, D. J. Cohen, E. Gervino, R. Laham, et al.
A Blinded, Randomized, Placebo-Controlled Trial of Percutaneous Laser Myocardial Revascularization to Improve Angina Symptoms in Patients With Severe Coronary Disease
J. Am. Coll. Cardiol., November 15, 2005; 46(10): 1812 - 1819.
[Abstract] [Full Text] [PDF]

Home page
 Ann. Thorac. Surg.Home page
M. Czerny, D. Zimpfer, J. Kilo, R. Gottardi, D. Dunkler, E. Wolner, and M. Grimm
Coronary reoperations: recurrence of angina and clinical outcome with and without cardiopulmonary bypass
Ann. Thorac. Surg., March 1, 2003; 75(3): 847 - 852.
[Abstract] [Full Text] [PDF]

Home page
 J Am Coll CardiolHome page
M. Saririan and M. J. Eisenberg
Myocardial laser revascularization for the treatment of end-stage coronary artery disease
J. Am. Coll. Cardiol., January 15, 2003; 41(2): 173 - 183.
[Abstract] [Full Text] [PDF]

Home page
 Card Surg AdultHome page
M. Ruel, R. A. Kelly, and F. W. Sellke
Therapeutic Angiogenesis, Transmyocardial Laser Revascularization, and Cell Therapy
Card. Surg. Adult, January 1, 2003; 2(2003): 715 - 750.
[Full Text]

Home page
 J Am Coll CardiolHome page
L. Aaberge, K. Rootwelt, S. Blomhoff, K. Saatvedt, M. Abdelnoor, and K. Forfang
Continued symptomatic improvement three to five years after transmyocardial revascularization with co2 laser: A late clinical follow-up of the norwegian randomized trial with transmyocardial revascularization
J. Am. Coll. Cardiol., May 15, 2002; 39(10): 1588 - 1593.
[Abstract] [Full Text] [PDF]

Home page
 Ann. Thorac. Surg.Home page
G. M. A. Dato, M. Hakimpour, M. Bacciega, M. di Summa, and G. Poletti
TMR and CABG: the best way to obtain a complete and a more lasting revascularization?
Ann. Thorac. Surg., June 1, 2000; 69(6): 1993 - 1994.
[Full Text] [PDF]

Home page
 J Am Coll CardiolHome page
L. Aaberge, K. Nordstrand, M. Dragsund, K. Saatvedt, K. Endresen, S. Golf, O. Geiran, M. Abdelnoor, and K. Forfang
Transmyocardial revascularization with CO2 laser in patients with refractory angina pectoris: Clinical results from The Norwegian Randomized Trial
J. Am. Coll. Cardiol., April 1, 2000; 35(5): 1170 - 1177.
[Abstract] [Full Text] [PDF]

Home page
 NEJMHome page
R. A. Lange and L. D. Hillis
Transmyocardial Laser Revascularization
N. Engl. J. Med., September 30, 1999; 341(14): 1074 - 1076.
[Full Text]


HOME HELP FEEDBACK SUBSCRIPTIONS ARCHIVE SEARCH TABLE OF CONTENTS
ANN THORAC SURG ASIAN CARDIOVASC THORAC ANN EUR J CARDIOTHORAC SURG
J THORAC CARDIOVASC SURG ICVTS ALL CTSNet JOURNALS
Copyright © 1999 by The Society of Thoracic Surgeons.